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Thursday, January 24, 2013

Kibera, Episode Two

We have completed 3 days in the Shining Hope facility, so it's time to tell you about it. Shining Hope is a gloriously successful NGO that sponsors many community projects in Kibera, one of which is the clinic in which we are working. Shining Hope is well known in Kibera, and there are many directional signs to its facilities, critical in an area without street signs, addresses (most of our patients have no address), or anything approaching a rational grid. The clinic is next door to the girls' school, which you may have seen in the lively You Tube video. Fhttp://video.msnbc.msn.com/rock-center/50502475. On beaks from the clinic we can climb three floors to the roof of the school, which features views of about 30 percent of Kibera, and, after lunch, perhaps 40 little girls in plaid uniforms racing around colorful and imaginative play structures. The favorite game seems to be competitive rolling of painted tires. When you get bored with that you can hide inside three stacked tires.

We have four examination rooms, each the size of a large walk in closet. The lighting is from a single naked incandescent bulb and whatever natural light comes in the window, along with children's crying, playing and singing, and neighbors' chatting. The uneven walls are brightly painted, often decorated with informational posters about child abuse and rape from US government agencies. Some of the floors slope noticeably. While the Shining Hope facilities seem to be made of concrete, the predominant building materials are corrugated metal, wooden poles and mud. It is warm in the exam rooms, but less warm downstairs where we do intake interviews and data entry, my jobs.The employees of the clinic are competent, hard working and endlessly accommodating. They, like our trainees, speak English well, as do many, but not all, of the patients. Thus we have informational material in English, Luo, and Swahili. The clinic personnel have been helping us out with the non-English speakers. Interviewing the patients has been extremely interesting. I have learned, for instance, that women in this culture simply do not smoke or drink, although men can - and do - do both. One woman told me she would not drink because she is a Christian. In response to the question about smoking, the women tended to wrinkle their noses and shake their heads in distaste. Almost all women have been tested for AIDS, and a shocking percentage are HIV positive, which makes them more susceptible to cervical cancer. If you are a volunteer, you may be interested in the lunch provided by the facility and the latrine situation. Lunch is simple, plentiful and hearty: greens, beans and a starch like congealed Cream of Wheat, or cabbage and beans. There is a tolerable squat latrine with 8 stalls donated by Newman's Own. There is water and soap outside to wash your hands. People line up to use the latrine. There are similar structures dotted throughout Kibera. There is also a water depot contributed by another donor, and there are similar water towers at points in the surrounding area. The slum is divided into neighborhoods, and it may be that these facilities are associated with different neighborhoods. Women line up throughout the day to collect water in yellow plastic containers, which they carry home on their heads. Sewers are open ditches on the sides of the road. Side alleys have no such ditches because they are too narrow. People sweep refuse into the ditches, little boys pee into them, and there are little bridges across them right up to the home entrance. I once saw water flowing in one of these sewers, but mostly they are stagnant. People use propane and charcoal for cooking. These, and cell phones, are some of the ways the slum dwellers compensate for the lack of the utility and city services we take for granted.

Perhaps the most gratifying thing that happens during the day for me is recording the performance of a cryo or LEEP procedure on a woman who has dysplasia, or diseased cervical cells, meaning those cells will not grow into a cancer. We effectively have prevented her from developing a deadly condition. Teaching local providers to screen and perform these types of procedures is what PINCC is all about.The largest and best constructed structures by far are the churches, of which we saw many. In this intensely inhabited area totally devoid of greenery, churches have surrounding open space. Some look like they predate the slum itself. Religion, mostly Christian, is pervasive in Kibera. Many business have religious themed names, such as the By God's Mercy Hair Salon.Cell phones are ubiquitous. In fact, cell phone companies are about the only international businesses with a presence in Kibera. If you long for a place without Walmart or Starbucks, this the the one for you. Perhaps the reason there are all these tiny businesses is that they do not (yet) have competition from big companies.

I do have to prepare you for the traffic, which is awful, and unpredictable. On our side of town people tend to drive nice Japanese cars and are generally courteous. Our amazingly patient and ever helpful driver Mike lives on the other side of town and reports that drivers there are aggressive and careless. There is a divided highway near us where traffic seems to flow, but all the other streets are two lanes and you can stand still for minutes at a time. It takes at least an hour to get to our clinic from the guest house. By the way, people drive on the left. It is not as chaotic as India, however, since here there are no cows, dogs, rickshaws, motorbikes, bicycle taxies, hand trollies, etc. competing for advantage.